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PubMed1989

Increase of walking capacity after acute aminophylline administration in intermittent claudication.

In the presence of peripheral atherosclerotic disease, inappropriate adenosine release during exercise might promote excessive arteriolar dilation leading to steal phenomena and ischemia. In order to test this hypothesis, IV aminophylline (6 mg/kg over fifteen minutes), a dosage known to effectively block adenosine receptors, was acutely administered--in a double-blind, placebo-controlled study design--in 13 patients with intermittent claudication and documented atherosclerotic disease. All patients performed two treadmill exercise tests at the same hour on two consecutive days, five minutes after aminophylline or placebo administration randomly allocated. Pain-free time was 109 +/- 133 (mean +/- SD) seconds after placebo and 173 +/- 165 seconds after aminophylline (p less than .01); maximum time to claudication was 273 +/- 191 seconds after placebo and 397 +/- 318 seconds after aminophylline (p less than .05). The authors conclude that intravenous aminophylline markedly increases the walking capacity in patients with intermittent claudication, possibly by preventing flow maldistribution phenomena through adenosine receptors blockade.

Aminophylline↗
PubMed1979

Effect of physical training on different categories of patients with intermittent claudication.

The effect of supervised training was studied in 68 patients with intermittent claudication. Maximal walking distance was measured on a treadmill. Eight of the patients had resting pain in the leg when recumbent (group A), 25 had an initial walking distance of less than 500 m (group B), 11 had an initial walking distance of 500--1 000 m (group C), 24 had coronary insufficiency (group D). The study shows that training should be undertaken for at least three months. In some patients with resting pain, training led to relief of pain and surgical treatment was not necessary. Almost all patients without signs of coronary insufficiency increased their walking distance, compared to only 14 of the 24 patients with coronary insufficiency. Walking distance increased significantly in groups B and C and no significant difference was found between patients and proximal or distal arterial stenosis.

Aged↗
PubMed1990

Placebo-controlled, double-blind study of the effect of verapamil in intermittent claudication.

The clinical effect of verapamil was tested in 24 patients with intermittent claudication in a randomized, placebo-controlled, double-blind, crossover study. Slow-release verapamil or placebo was given for two periods of three weeks. The walking distance, systemic blood pressure, and ankle-brachial blood pressure index were measured. Furthermore, a possible change in peripheral vascular tone was provoked by hyperventilation. The walking distance rose after both verapamil (40%) and placebo (31%) (p less than 0.01 for both) but tended to increase only after verapamil (7%) as compared with placebo. Blood pressure fell equally after both verapamil and placebo (p less than 0.05 for both). Verapamil did not influence the ankle-branchial blood pressure index. No signs of vasoactivity in the lower extremities were seen after hyperventilation. Although the greatest individual improvements in walking distance were seen after verapamil administration, it was not possible to predict positive responders among the patients.

Adult↗
PubMedDate not supplied

[Double-blind randomized comparative study of nicergoline naftidrofuryl on the quality of life in chronic obliterative arteriopathy of lower limbs with intermittent claudication].

The functional limitation of patients with obliterative arterial disease, and with intermittent claudication, damages their quality of life. The purpose of this trial was to compare the effects of nicergoline and naftidrofuryl on the quality of life and the functional discomfort of the 131 patients with claudication. It was a multicentre, randomised, double-blind trial with parallel groups. The patients were asked to complete a quality of life questionnaire and a Visual Analogue Scale, and to evaluate the number of steps on flat ground before the pain began. After 6 months of treatment, we observed, for all treatments combined, a significant improvement (p = 0.0001) in the quality of life and in the functional discomfort. Three variables favoured nicergoline: the estimated time before the onset of the pain (p = 0.003), the functional discomfort quantified by the Visual Analogue Scale (p < 0.05), the distance covered on flat ground (p = 0.013). The other variables, and especially the total score on the self-questionnaire, confirmed this impression, without reaching significance (p = 0.136). The data suggest that in terms of quality of life nicergoline is superior. The clinical tolerance is good and comparable between the two treatments.

Adult↗
PubMed1990

Prevention of myocardial infarction and stroke in patients with intermittent claudication; effects of ticlopidine. Results from STIMS, the Swedish Ticlopidine Multicentre Study.

The Swedish Ticlopidine Multicentre Study (STIMS) was a double-blind placebo-controlled trial designed to determine whether ticlopidine, a platelet antiaggregatory agent, reduces the incidence of myocardial infarction, stroke and transitory ischaemic attacks in patients with intermittent claudication. A total of 687 patients was monitored for a minimum of 5 years or until an end-point was reached. The number of end points (99 vs. 89), analysed according to the intention-to-treat principle, was 11.4% lower in the ticlopidine group (P = 0.24). The mortality rate was 29.1% lower in the ticlopidine group (64 vs. 89, P = 0.015); this observation could be accounted for by a reduced mortality from ischaemic heart disease. On-treatment analysis showed there to be significantly fewer end points in the ticlopidine group (47 vs. 76, P = 0.017). Diarrhoea was the most common side-effect. Reversible leucopenia or thrombocytopenia was reported in seven patients on ticlopidine. It is concluded that the high morbidity and mortality from cardio- and cerebrovascular disease in patients with intermittent claudication can be reduced by long-term treatment with ticlopidine.

Aged↗
PubMed1996

Progress in the prostaglandin E1-therapy of the intermittent claudication by means of bolus injections of LIPO-prostaglandin E1 (LIPO-PGE1).

OBJECTIVE: We compared the efficacy of a bolus injection (5 min) of LIPO-PGE1 (Prostaglandin E1 in lipid emulsion) with conventional PGE1-cyclodextrin (PGE1-cyclodextrin) infusions (2 h) in patients with intermittent claudication. The quantitative blood-flow in the common femoral artery was measured using a computerized ultrasound Doppler system (MAVIS). We also monitored the transcutaneous oxygen pressure, the skin temperature on the foot, and the reactive change in blood pressure and pulse as well as side effects. RESULTS: Dose finding of LIPO-PGE1: After bolus injection of 30, 50, and 80 micrograms LIPO-PGE1 a significant dose-dependent increase of the blood flow in the leg (+96.9%, 80 micrograms) with a peak 3 h after injection was seen. After LIPO-PGE1 we observed an enhanced microcirculation (significant rise in the transcutaneous oxygen pressure and the skin temperature on the foot). We noted longer lasting pharmacodynamic properties with LIPO-PGE1 (50 micrograms) compared to PGE1-cyclodextrin (60 micrograms). Comparison to PGE1-cyclodextrin: In a cross-over, placebo-controlled study, 20 patients with intermittent claudication received 4 weeks therapy with a bolus of 50 micrograms LIPO-PGE1 or a 2 h infusion of 60 micrograms PGE1-cyclodextrin per day. A significant increase in the blood flow was measured at the end of 4 weeks therapy compared to the initial values before treatment. This rise correlates significantly with the increase in the patient's maximal walking distance (+112%, LIPO-PGE1). Compared to conventional PGE1-cyclodextrin infusions given over 2 h, a clearly prolonged increase in perfusion of the affected limb after LIPO-PGE1 was demonstrated. No serious adverse effects were observed.

Aged↗
PubMed1994

A marked decline in the prevalence and incidence of intermittent claudication in Icelandic men 1968-1986: a strong relationship to smoking and serum cholesterol--the Reykjavik Study.

The epidemiology of peripheral vascular disease has been studied much less extensively than the epidemiology of coronary heart disease (CHD). The prospective Reykjavik Study gave an opportunity to monitor secular trends from 1968 to 1986 of clinical intermittent claudication (IC) amongst Icelandic males, aged 34-80 and to assess the importance of possible risk factors. Both prevalence and incidence of IC decreased sharply after 1970 in all age groups, and this decline occurred a few years earlier than the decline of CHD in Iceland. The only significant risk factors for intermittent claudication, in addition to age, were smoking which increased the risk of IC 8- to 10-fold and serum cholesterol level. Approximately one-half of the striking decline in the incidence of IC can be explained by decreased smoking and cholesterol levels amongst Icelandic men. A follow-up study verified that IC patients stood twice the risk of cardiovascular and total mortality as non-IC patients, indicating that IC is a high risk group which should receive all possible preventive measures.

Adult↗
PubMed1998

Cilostazol has beneficial effects in treatment of intermittent claudication: results from a multicenter, randomized, prospective, double-blind trial.

BACKGROUND: Cilostazol is a new phosphodiesterase inhibitor that suppresses platelet aggregation and also acts as a direct arterial vasodilator. This prospective, randomized, placebo-controlled, parallel-group clinical trial evaluated the efficacy of cilostazol for treatment of stable, moderately severe intermittent claudication. METHODS AND RESULTS: Study inclusion criteria included age > or =40 years, initial claudication distance (ICD) on treadmill (12.5% incline, 3.2 km/h) between 30 and 200 m, and confirmation of diagnosis of chronic lower-extremity arterial occlusive disease. After stabilization and single-blind placebo lead-in, 81 subjects (62 male, 19 female) from 3 centers were randomized unequally (2:1) to 12 weeks of treatment with cilostazol 100 mg PO BID or placebo. Primary outcome measures included ICD and maximum distance walked (absolute claudication distance, or ACD). Secondary outcome measures included ankle pressures, subjective assessments of benefit by patients and physicians, and safety. Treatment and control groups were similar with respect to age, severity of symptoms, ankle pressures, and smoking status. Statistical analyses used intention-to-treat analyses for each of 77 subjects who had > or =1 treadmill test after initiation of therapy. Comparisons between groups were based on logarithms of ratios of ICD and ACD changes from baseline using ANOVA test at last treatment visit. The estimated treatment effect showed a 35% increase in ICD (P<0.01) and a 41% increase in ACD (P<0.01). There was no significant change in resting or postexercise ankle/brachial indexes. Patients' and physicians' subjective assessments corroborated the measured improvements in walking performance observed in the cilostazol-treated group. CONCLUSIONS: Cilostazol improved walking distances, significantly increasing ICD and ACD. The data suggest cilostazol is safe and well tolerated for the treatment of intermittent claudication.

Adult↗
PubMed1995

Hydrotherapy of patients with intermittent claudication: a novel approach to improve systolic ankle pressure and reduce symptoms.

OBJECTIVE: To study the effects of alternating cold and hot water therapy on walking ability and systolic blood pressure in claudicants. EXPERIMENTAL DESIGN: A prospective case study with repeated measurements before and 1, 4 and 12 months after treatment. The systolic blood pressure levels were measured with an occlusion cuff for brachial and ankle and with a strain gauge for the first toe. STUDY POPULATION: Twenty consecutively included patients, 11 women and 9 men; mean age 73.9 yrs, with intermittent claudication according to clinical examination and ankle-arm systolic blood pressure (AAI) below 0.90. INTERVENTION: Alternate hot and cold hydrotherapy of the legs were given at ten 25-minute treatments during a three-week period. The outcome measures were maximal walking ability (MW), walking ability before pain (PW) and systolic blood pressures of toe, ankle, arm and AAI. RESULTS: Fourteen patients (70%) reported reduced pain after treatment and their PW increased from 134 +/- 29 m to 415 +/- 119 m 12 months later (p < 0.05) and the MW in the total group increased form 348 +/- 75 m to 523 +/- 103 m. Systolic blood pressure increased in right ankle and toe one month after treatment in the total group. Among those who reported improved walking ability one year after treatment, systolic blood pressure in both right and left ankles and toes increased; e.g. right toe increasing from 72 +/- 7 to 86 +/- 2 (p < 0.001). Improvements of systolic blood pressure in left and right leg and changes of walking ability were correlated, in the order of 0.60 to 0.81, p < 0.05. CONCLUSIONS: Showering the legs of claudicants improved walking ability and blood pressures which sustained up to 1-year later. This therapy might be an additional alternative to conservative treatment of intermittent claudication.

Aged↗
PubMed1962

The diagnosis of ischaemic heart pain and intermittent claudication in field surveys.

Hospital studies were used to identify those characteristics of angina pectoris, cardiac infarction and intermittent claudication which most effectively distinguish these conditions from other causes of chest or leg pain. These are used to formulate precise definitions for epidemiological use and to form the basis of a standardized questionnaire.Agreement on the use of such a questionnaire would permit international comparisons of the prevalence of these conditions, as defined. This would not hinder the collection of additional information, as required in particular studies.As compared with physicians' diagnoses, the questionnaire had high specificity and reasonably good sensitivity. Interpretation of subjects' answers presents no serious difficulties. There is evidence that the diagnosis of angina pectoris presents special problems in populations with a high prevalence of chronic bronchitis.

Angina Pectoris↗
PubMed1976

Intermittent claudication of the foot in view of foot muscle blood flow measured by 133Xe clearance technique and arteriographic findings.

In 20 limbs of 10 healthy subjects and 55 limbs of 41 patients with occlusive areterial diseases of the legs, muscle blood flow was measured in the flexor hallucis brevis muscle by 133Xe clearance technique. The clearance curves after the ischemic exercise differenciated limbs with intermittent claudication of the foot from normals and limbs without claudication. An attempt was also made with arteriographic findings in 102 limbs of 84 patients with occlusions of the leg and/or foot arteries only. From results obtained, it is concluded that 133Xe clearance technique applied in the flexor hallucis brevis muscle can be used for diagnosis of foot pain during walking of uncertain origin and intermittent claudication of the foot is caused by severe circulatory insufficiencies of the plantar muscles during walking in the patients with involvements of the posterior tibial and/or plantar arteries.

Adult↗
PubMed1984

Trental 400 in the treatment of intermittent claudication: results of long-term, placebo-controlled administration.

A double-blind, randomized, placebo-controlled long-term clinical study of Trental 400 was carried out, partly under cross-over design, partly as a parallel-group study, in 36 patients suffering from chronic arterial obstructive disorders in the lower limbs, associated with intermittent claudication, in order to evaluate the effectiveness and the safety of this drug administered t.i.d. over a period of 6 months. This controlled period was preceded by a placebo run-in period of 3 months. The clinical results under Trental 400 showed a statistically significant within group improvement of painfree and maximum walking parameters (p less than 0.05) corresponding to an increase to baseline by +96% to +139% respectively and also in comparison to placebo (p less than 0.05). The alterations of walking parameters within the placebo groups, ranging between -25% and +28% were not significant. The subjective parameters (rest pain, paraesthesias, muscular cramps and sensation of heaviness in the legs) paralleled the course of the walking parameters. Under Trental 400, 24 out of 36 patients reported an improvement of these symptoms compared to 7 under placebo. Trental 400 was well tolerated. Minor side effects were mentioned by 7 out of 36 patients. One patient had to stop the drug treatment because of persisting prickling sensation and subsequent insomnia. Drug-related changes in the laboratory findings could not be detected; vital signs varied in function of age, concomitant drug treatments and seasonal factors. The results obtained in these studies suggest Trental 400 as a drug of choice for treating patients with intermittent claudication due to peripheral arterial obstruction according to stage II or III after Fontaine.

Aged↗
PubMed1990

[Blood and plasma viscosity and the distance of intermittent claudication in patients with type II diabetes and thrombophlebitis].

In 49 patients with insulin-resistant diabetes, with ischaemia of the lower extremities blood viscosity was measured at low coagulation rates and plasma viscosity was determined also. Moreover plasma measurements were done of total lipids, alpha-, pre-beta-, and beta lipoproteins, triglycerides, total cholesterol, free fatty acids, and, besides that, the hematocrit was measured. Immediately after blood sampling for rheological and biochemical investigations the distance of intermittent claudication was measured. A rather considerable increase of blood and plasma viscosity was noted in the patients in comparison with controls, other findings included disturbances of lipid metabolism, increased fibrinogen level, and a negative correlation between the distance of intermittent claudication and blood and plasma viscosity.

Aged↗
PubMed2002

Prostanoids in the treatment of intermittent claudication--a meta-analysis.

BACKGROUND: Numerous studies have established the efficacy of prostanoids in PAD stages III and IV, but the role of prostanoids as an alternative or additive treatment in patients suffering from PAD II is less clear. To resolve this uncertainty we performed a meta-analysis of all randomised controlled studies analysing effects of prostanoids in patients suffering from intermittent claudication. METHODS: 96 studies have been screened by computerised searches of MEDLINE and EMBASE. Relevant studies were pooled in Cochrane's Review-manager 4.1. RESULTS: 19 studies were included for further analysis. Five studies could not be pooled for analysing walking distances, because standard deviations were not stated. Eight studies compared effects of any prostanoid i.v. vs. placebo. In total 557 patients (281/276) were included for analysis of painfree--walking distance (PFWD) and 519 patients (262/257) for analysis of maximum walking distance (MWD). Prostanoids compared to placebo significantly improved mean PFWD by 28% (7%-49%, P = 0.008) and mean MWD by 30% (11%-50%, P = 0.002). At least one adverse reaction was reported from 39.6% of the patients treated with prostacyclin and its analogues and from 13.7% of the patients treated with prostaglandin E1. CONCLUSION: Patients suffering from intermittent claudication benefit from administration of prostaglandin E1 by a significant improvement of their walking capacity.

Arterial Occlusive Diseases↗
PubMed2006

Persistent sciatic artery: an uncommon cause of intermittent claudication.

Persistent sciatic artery (PSA) is a rarely seen variation of the lower limb vessels. Anatomically the PSA is the continuation of internal iliac arteries. It follows the sciatic nerve from the sciatic foramen to the level of the knee. We report our experience with conservative therapy in a patient with complete occlusion of a PSA. A 54-year-old man with typical symptoms of intermittent claudication on the left limb was referred to our Department. After clinical examination Doppler and duplex sonography were performed. Angiography showed bilateral PSA. On the left side the PSA was occluded. The patient received 20 intravenous courses of prostaglandin E1 for 4 weeks, followed by oral anticoagulation with phenprocoumon for life (INR: 2.5-3.5). After 3 years therapy he does not show any typical symptoms of intermittent claudication or limb ischemia. This case shows that conservative therapy may be effective. However, it has to be emphasised that this approach requires frequent clinical and duplex sonography follow-up every 3 to 6 months with oral anticoagulation.

Alprostadil↗
PubMed1976

Prevalence of ischaemic heart disease, arterial hypertension and intermittent claudication, and distribution of risk factors among middle-aged men in Moscow and Berlin.

The initial examinations of prospective epidemiological studies of the same kind performed in random samples of 50-54 years old men from Moscow and Berlin showed the following prevalence rates (each first figure for Moscow, second for Berlin): ischaemic heart disease 14.4/13.6%, arterial hypertension 18.0/19.0%, intermittent claudication 6.9/3.4%, cigarette smoking 46.5/51.4%, overweight 22.9/21.9%, impaired glucose tolerance 36.6/42.5%. Hypercholesterolaemia (24.6/8.1%) was not comparable because different determination methods were used. In both population samples almost a half of IHD and 1/3-1/2 of hypertension cases were newly detected only by the study examinations. More than 80% of the 50-54 years old men showed the presence of one or more risk factors. The following significant relationships between disease groups and risk factors were found: for IHD, with hypertension, impaired glucose tolerance, and hypercholesterolaemia (Moscow only); for hypertension, with overweight, impaired glucose tolerance, and hypercholesterolaemia (Moscow only); for intermittent claudication, with cigarette smoking, impaired glucose tolerance, and hypercholesterolaemia (Moscow only). These comparative studies demonstrate the benefit and need of further common research and efforts for prevention and control of cardiovascular diseases.

Berlin↗
PubMed1987

Placebo-controlled trial of ketanserin in the treatment of intermittent claudication.

The effect of ketanserin on the symptoms of 21 patients with stable intermittent claudication was examined in a double-blind, placebo-controlled, parallel-group study. Benefit was assessed by repeated treadmill exercise tests, recording claudication and total walking times. After three months' treatment with ketanserin (mean dose 167 mg/day) there was no significant change in claudication time (mean change + 12%, 95% CI -9; + 33%) or total walking time (mean change -14%, 95% CI -47%; + 19%). The confidence intervals show that ketanserin treatment is unlikely to be associated with clinically important improvement.

Blood Pressure↗